Walter Reed National Military Medical Center, Bethesda, Maryland, USA.
Diabetes Care. 2013 Apr;36(4):786-92. doi: 10.2337/dc12-1225. Epub 2012 Nov 19.
OBJECTIVE: To characterize glucose response patterns of people who wore a real-time continuous glucose monitor (RT-CGM) as an intervention to improve glycemic control. Participants had type 2 diabetes, were not taking prandial insulin, and interpreted the RT-CGM data independently. RESEARCH DESIGN AND METHODS: Data were from the first 12 weeks of a 52-week, prospective, randomized trial comparing RT-CGM (n = 50) with self-monitoring of blood glucose (n = 50). RT-CGM was used in 8 of the first 12 weeks. A1C was collected at baseline and quarterly. This analysis included 45 participants who wore the RT-CGM ≥4 weeks. Analyses examined the RT-CGM data for common response patterns-a novel approach in this area of research. It then used multilevel models for longitudinal data, regression, and nonparametric methods to compare the patterns of A1C, mean glucose, glycemic variability, and views per day of the RT-CGM device. RESULTS: There were five patterns. For four patterns, mean glucose was lower than expected as of the first RT-CGM cycle of use given participants' baseline A1C. We named them favorable response but with high and variable glucose (n = 7); tight control (n = 14); worsening glycemia (n = 6); and incremental improvement (n = 11). The fifth was no response (n = 7). A1C, mean glucose, glycemic variability, and views per day differed across patterns at baseline and longitudinally. CONCLUSIONS: The patterns identified suggest that targeting people with higher starting A1Cs, using it short-term (e.g., 2 weeks), and monitoring for worsening glycemia that might be the result of burnout may be the best approach to using RT-CGM in people with type 2 diabetes not taking prandial insulin.
目的:描述佩戴实时连续血糖监测仪(RT-CGM)作为改善血糖控制干预措施的患者的血糖反应模式特征。参与者患有 2 型糖尿病,未服用餐时胰岛素,且独立解读 RT-CGM 数据。
研究设计和方法:数据来自一项为期 52 周的前瞻性随机对照试验的前 12 周,比较了 RT-CGM(n=50)与自我血糖监测(n=50)。在最初的 12 周中,有 8 周使用 RT-CGM。在基线和每季度采集 A1C。本分析纳入了 45 名至少佩戴 RT-CGM 4 周的参与者。分析检查了 RT-CGM 数据中的常见反应模式-这是该研究领域的一种新方法。然后使用多水平模型进行纵向数据分析、回归分析和非参数方法比较 RT-CGM 设备的 A1C、平均血糖、血糖变异性和每日视图的模式。
结果:存在 5 种模式。对于前 4 种模式,鉴于参与者的基线 A1C,在首次使用 RT-CGM 循环时,平均血糖低于预期。我们将它们命名为有利反应但伴有高且多变的血糖(n=7);严格控制(n=14);血糖恶化(n=6);以及逐渐改善(n=11)。第五种是无反应(n=7)。在基线和纵向研究中,模式之间的 A1C、平均血糖、血糖变异性和每日视图均存在差异。
结论:确定的模式表明,对于未服用餐时胰岛素的 2 型糖尿病患者,使用 RT-CGM 的最佳方法可能是针对初始 A1C 较高的人群,短期(例如 2 周)使用,并监测可能因精疲力竭而导致的血糖恶化。
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